A meta-analysis comparing volar locking plates and cast immobilization for distal radius fractures in the elderly.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2024-11-27 DOI:10.1186/s13018-024-05216-7

Jingyi Yang, Yating Li, Xiaoyan Li, Nari Wulan

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引用次数: 0

Abstract

Background: The long-term outcomes (≥ 2 years of follow-up) of volar locked plate (VLP) fixation versus closed reduction and casting (CRC) for the treatment of displaced distal radial fractures (DRFs) remain unclear. This study aimed to conduct a meta-analysis comparing the long-term clinical outcomes of VLP and CRC in elderly patients (aged ≥ 60 years).

Methods: A comprehensive search of PubMed, Web of Science, and Cochrane Library was performed to identify studies comparing the long-term outcomes of VLP and CRC for DRFs. Only randomized controlled trials (RCTs) with a mean follow-up duration of at least 2 years and participants aged 60 years or older were included. The risk of bias in the included studies was assessed. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, EuroQol 5 Dimension 5-level score (EQ-5D-5 L), grip strength, and incidence of reoperation.

Results: Four RCTs, comprising 423 patients, were included. The meta-analysis revealed that VLP fixation was associated with significantly improved outcomes compared to CRC in terms of PRWE score (pooled mean difference: -6.21; 95% CI: -10.28 to -2.15; p = 0.003), DASH score (pooled mean difference: -8.18; 95% CI: -13.35 to -3.01; p = 0.002), and grip strength (pooled mean difference: -6.63; 95% CI: 0.25 to 13.01; p = 0.04). There were no significant differences in EQ-5D-5 L score (95% CI: -0.08 to 0.05; p = 0.74) or incidence of reoperation (RR = 0.56; 95% CI: 0.22 to 1.42; p = 0.22).

Conclusions: A two-year follow-up of displaced DRFs in elderly patients showed no significant long-term clinical advantage of VLP fixation over CRC.

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对老年人桡骨远端骨折的外侧锁定钢板和石膏固定进行比较的荟萃分析。

背景：在治疗移位的桡骨远端骨折（DRFs）时，沃尔锁定钢板（VLP）固定与闭合复位和石膏固定（CRC）的长期疗效（≥2年的随访）仍不明确。本研究旨在对老年患者（年龄≥ 60 岁）的 VLP 和 CRC 的长期临床疗效进行荟萃分析比较：方法：对PubMed、Web of Science和Cochrane图书馆进行了全面检索，以确定比较VLP和CRC对DRFs的长期疗效的研究。仅纳入了平均随访时间至少为 2 年、参与者年龄在 60 岁或以上的随机对照试验 (RCT)。对纳入研究的偏倚风险进行了评估。主要研究结果为患者评定的腕部评估（PRWE）。次要结果包括手臂、肩部和手部残疾（DASH）调查问卷、EuroQol 5 Dimension 5 级评分（EQ-5D-5 L）、握力和再手术发生率：结果：共纳入了四项研究，包括 423 名患者。荟萃分析显示，VLP固定与CRC相比，在PRWE评分（汇集平均差异：-6.21；95% CI：-10.28至-2.15；p = 0.003）、DASH评分（汇集平均差异：-8.18；95% CI：-13.35至-3.01；p = 0.002）和握力（汇集平均差异：-6.63；95% CI：0.25至13.01；p = 0.04）方面，VLP固定显著改善了疗效。EQ-5D-5 L 评分（95% CI：-0.08 至 0.05；p = 0.74）或再手术发生率（RR = 0.56；95% CI：0.22 至 1.42；p = 0.22）无明显差异：对老年患者移位的DRF进行的为期两年的随访显示，VLP固定与CRC相比没有明显的长期临床优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.